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    Etac is a world-leading developer and provider of ergonomic assistive devices and patient handling equipment.

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    /globalassets/0-international/campaigns/rehacare-2024/klaxon2_480x480.jpg?width=1280&Quality=90&rmode=max&scale=down

    Explore our new range of Klaxon power assists

    Innovative add-ons transforming manual wheelchairs into powered ones with a simple click. Riders can enjoy increased mobility in both urban and countryside terrain, making travel, social activities, and exploration more accessible.

    Learn more
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    Explore our case stories and discover the wide applications of our products.

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    Sustainability

    Sustainability is a high priority for Etac and is closely linked to the long-term development and success of our business.

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  • Products
    • Pediatrics
      • Wheelchairs & seating
      • Standing
      • Walking
      • Toilet & bath
      • Transportation
      • Accessories
    • Patient handling
      • Ceiling lifts
      • Mobile lifts
      • Sit-to-stand aids
      • Slings
      • Manual transfer
    • Bathroom aids
      • Bathing and showering
      • Mobile shower commodes
      • Toileting
      • Accessories
    • Pressure care
      • Seat cushions
      • Smart seating technology
      • Accessories
    • Small aids for daily living
      • Stocking aids
      • Kitchen aids
      • Personal care
      • Reachers
  • Brands
    • Etac
    • Star
    • R82
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    • Convaid
    • Molift
    • Ki
    • Immedia
    • Axiom
  • Knowledge
    • Insights
      • Case stories
      • COVID-19: Safe patient handling
      • A world of pediatrics
    • Education
      • E-learning
      • Letter of medical necessity
  • Support
    • Ordering
      • Order forms
      • Freight terms
    • Resources
      • Literature
      • Videos
      • Media gallery
      • Letter of medical necessity
      • Customer & credit application
    • Product support
      • Returns
      • Warranty
      • Product recall information
      • Discontinued products
  • News
  • About us
    • About Etac
      • Company
      • Product brands
      • History
      • Legal
    • Sustainability
      • Our work
      • Sustainability reports
      • Codes of conduct
    • News & social media
      • Newsroom
      • Social media
      • Newsletter sign-up
    • Careers at Etac
      • Current openings
      • Apply
    • Contact us
      • Locate dealer
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  • Order forms
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  • Locate dealer
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    • Associated websites
      • Ki Mobility
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  • Ordering
    • Order forms
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    • Customer & credit application
  • Product support
    • Returns
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    • Product recall information
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Order forms

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Click the product names to view and download the order form.

To use the “Quote” and “Order” buttons in the PDF, please make sure to open the document in Adobe Acrobat. We will reply via email with either a quote or order confirmation by the next working day. For more assistance please contact our Customer Service.

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Order forms (USD)
  • Convaid Carrot 3 Booster seat
  • Convaid Carrot 3 Child Restraint System
  • Convaid Coaster
  • Convaid Coaster Scout
  • Convaid Cruiser
  • Convaid Cruiser Scout
  • Convaid EZRider
  • Convaid Rodeo
  • Convaid Rodeo without seating
  • Convaid Safari
  • Convaid Trekker
  • R82 Caribou
  • R82 Chilla
  • R82 Crocodile
  • R82 Flamingo
  • R82 Gazelle
  • R82 Heron
  • R82 Manatee
  • R82 Meerkat
  • R82 Mustang
  • R82 Rabbit Up
  • R82 Vests & Belts
  • R82 x:panda
  • R82 x:panda shape infant seat
  • R82 x:panda shape simple seat
  • R82 x:panda shape advanced seat
Green_image_850x10.jpg
Order forms (CAD)
  • Convaid Carrot 3 Booster seat
  • Convaid Carrot 3 Child Restraint System
  • Convaid Coaster
  • Convaid Cruiser
  • Convaid EZRider
  • Convaid Rodeo
  • Convaid Rodeo without seating
  • Convaid Safari
  • Convaid Trekker
  • R82 Caribou
  • R82 Caribou AADL
  • R82 Chilla
  • R82 Crocodile
  • R82 Crocodile AADL
  • R82 Flamingo
  • R82 Gazelle
  • R82 Gazelle AADL
  • R82 Heron
  • R82 Manatee
  • R82 Manatee AADL
  • R82 Meerkat
  • R82 Meerkat AADL
  • R82 Mustang
  • R82 Mustang AADL
  • R82 Rabbit Up
  • R82 Rabbit Up AADL
  • R82 Vests & Belts
  • R82 x:panda
  • R82 x:panda shape infant seat
  • R82 x:panda shape simple seat
  • R82 x:panda shape advanced seat
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Etac

5201 Woodward Dr
Stevens Point, WI 54481

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